N-Terminal Pro-Brain Natriuretic Peptide as a Biomarker for Hypertensive Disorders of Pregnancy

Abstract

We tested the hypothesis that the cardiac biomarker N-terminal pro-brain natriuretic peptide would be elevated in hypertensive disorders of pregnancy, with an increase in levels of this biomarker across increasing gradations of disease severity. We performed a case-controlled study of women admitted to labor and delivery at the Hospital of the University of Pennsylvania between 24 and 42 weeks of gestation. Cases had hypertension that developed after 20 weeks of gestation, and controls were normotensive women presenting for delivery. N-terminal pro-brain natriuretic peptide levels were compared between cases ( N = 83) and controls ( N = 290). Cases were subclassified into gestational hypertension ( N = 20) and mild ( N = 15) and severe preeclampsia ( N = 48), and N-terminal pro-brain natriuretic peptide levels were compared between these subgroups. N-terminal pro-brain natriuretic peptide levels were higher in cases than in controls (81 pg/mL versus 37 pg/mL, P < 0.001), with a graded increase in levels from gestational hypertension (64 pg/mL) to preeclampsia (89 pg/mL) to severe preeclampsia (157 pg/mL; P < 0.001). Each log increase in N-terminal pro-brain natriuretic peptide doubled the risk of preeclampsia (odds ratio = 2.10 P < 0.001). N-terminal pro-brain natriuretic peptide levels were increased in hypertensive disorders of pregnancy and discriminate between subcategories of disease.

Cardiovascular haemodynamics in pre-eclampsia using brain naturetic peptide and tissue Doppler studies : cardiovascular topics

“…Recent studies have confirmed that BNP concentrations are elevated in PE and other hypertensive disorders of pregnancy 19-22. The increased serum BNP levels in PE are greater than that documented in normotensive pregnancies,23,24 suggesting that BNP activation in PE is a response to changes in the maternal circulation that reflect the pathophysiological changes in the utero–placental unit.…”

Left ventricular function of patients with pregnancy‐induced hypertension evaluated using velocity vector imaging echocardiography and N‐terminal pro‐brain natriuretic peptide

“…It has been suggested that N‐terminal pro‐brain natriuretic peptide (NT‐pro‐BNP) may be closely associated with cardiovascular damage, as it reflects ventricular function . It has also been demonstrated that the NT‐pro‐BNP levels of women with severe preeclampsia is significantly higher than that of women with uncomplicated pregnancies …”

Addition of N‐terminal pro‐B natriuretic peptide to soluble fms‐like tyrosine kinase‐1/placental growth factor ratio > 38 improves prediction of pre‐eclampsia requiring delivery within 1 week: a longitudinal cohort study

“…Moreover, PE is a risk factor for future cardiovascular disease. In particular, N‐terminal pro‐B natriuretic peptide (NT‐proBNP), which is released from cardiac myocytes in response to myocardial stretch or ischemia and is used as a biomarker of chronic heart failure in non‐obstetric populations, is present at higher concentrations in women with PE. In pregnancies complicated by PE, there appears to be a graded increase in natriuretic peptide levels with increasing severity of the disease, which may predict cardiovascular complications.…”